Healthcare Provider Details

I. General information

NPI: 1427980515
Provider Name (Legal Business Name): AIDAN BLACK MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 160TH ST S STE 101
SPANAWAY WA
98387-8508
US

IV. Provider business mailing address

622 S 320TH ST STE A
FEDERAL WAY WA
98003-4895
US

V. Phone/Fax

Practice location:
  • Phone: 253-904-6038
  • Fax:
Mailing address:
  • Phone: 360-306-0682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70132956
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMHCA.MC.70132956
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: